Minimally invasive guides and cutting instruments

ABSTRACT

A surgical guide includes a first guide arm extending from a first end to a second end on a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end on a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A pivot element couples the first end of the first guide arm to the first end of the second guide arm such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.

FIELD OF THE INVENTION

This disclosure relates generally to surgical guides and methods of use for minimally invasive surgery and, more specifically, to surgical guides and methods of use for Charcot minimally invasive surgery.

BACKGROUND

Arthrodesis refers to surgical fixation of a joint, ultimately resulting in bone fusion. An arthrodesis procedure induces ankylosis performed to relieve pain or provide support in a diseased or injured joint. Tibiotalocalcaneal (“TTC”) or tibiocalcaneal (“TC”) arthrodesis is a salvage procedure for the treatment of joint disease or pain and dysfunction due to arthritic ankle and subtalar joints, e.g., Charcot disease. In performing ankle and subtalar arthrodesis, the surgeon may wish to achieve anatomic alignment, pain relief, and a stable, plantigrade foot. Secure fixation while preserving the surrounding soft tissue can also contribute to a successful outcome.

Anatomic alignment, pain relief, stabilization, or other desired surgical outcomes may require cutting or other bone removal to form a cavity, wedge, or other space within or between bones for alignment and repositioning of the bones. Accurate postioning and formation of cuts in the bones is essential for ensuring proper relief and treatment of Charcot disease or other arthrodesis. Current systems for forming cuts present infection risks, slow tissue healing, and requires the use of frames and/or burrs that is time consuming and requires long incision paths.

SUMMARY

In some embodiments, a surgical guide is disclosed. The surgical guide includes a first guide arm extending from a first end to a second end on a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end on a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A pivot element couples the first end of the first guide arm to the first end of the second guide arm such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.

In various embodiments, a surgical method is disclosed. The surgical method includes a step of positioning a surgical guide adjacent to a bone. The surgical guide includes a first guide arm extending substantially on a first longitudinal axis and defining a first plurality of openings, a second guide arm extending substantially on a second longitudinal axis and defining a second plurality of openings, and a pivot element coupling the first guide arm to the second guide arm. A first guide element is inserted through a selected one of the first plurality of openings defined by the first guide arm. The first guide arm and the second guide arm are pivoted about the pivot element to adjust an angular distance between the first guide arm and the second guide arm. A second guide element is inserted through a selected one of the second plurality of openings defined by the second guide arm. A wedge osteotomy is formed in the bone. The first guide element and the second guide element are configured to position a cutting guide for forming the wedge osteotomy.

In various embodiments, a surgical guide is disclosed. The surgical guide includes a first guide arm extending from a first end to a second end on a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end on a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A first slide element is coupled to the first end of the first guide arm. A first extension element extends from a first end to a second end on a third longitudinal axis and defining a first adjustment slot extending substantially on the third longitudinal axis. The first slide element is positioned at least partially within the first slot and is slideable on the third longitudinal axis. A second slide element coupled to the first end of the second guide arm. A second extension element extends from a first end to a second end on a fourth longitudinal axis and defines a second adjustment slot extending substantially on the fourth longitudinal axis. The second slide element is positioned at least partially within the second slot and is slideable on the fourth longitudinal axis. A pivot element couples the first end of the first extension element to the first end of the second extension element such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.

BRIEF DESCRIPTION OF THE FIGURES

The features and advantages of the present invention will be more fully disclosed in, or rendered obvious by the following detailed description of the preferred embodiments, which are to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein:

FIG. 1 illustrates an isometric view an adjustable surgical guide, in accordance with some embodiments

FIG. 2 illustrates a top view of the adjustable surgical guide of FIG. 1, in accordance with some embodiments.

FIG. 3 illustrates a side view of the adjustable surgical guide of FIG. 1, in accordance with some embodiments.

FIG. 4 illustrates a cross-sectional view of a pivot element of the adjustable surgical guide of FIG. 1 taken along line A-A, in accordance with some embodiments.

FIG. 5 illustrates an isometric view of an adjustable surgical guide including a plurality of scallop guides, in accordance with some embodiments.

FIG. 6 illustrates a top view of the adjustable surgical guide of FIG. 5, in accordance with some embodiments.

FIG. 7 illustrates a cross-sectional view of the adjustable surgical guide of FIG. 5 taken along line A-A, in accordance with some embodiments.

FIG. 8 illustrates a cross-sectional view of a scallop guide of the adjustable surgical guide of FIG. 5 taken along line B-B, in accordance with some embodiments.

FIG. 9 illustrates an isometric view of an adjustable surgical guide including guide arms defining adjustment slots, in accordance with some embodiments.

FIG. 10 illustrates a top view of the adjustable surgical guide of FIG. 9, in accordance with some embodiments.

FIG. 11 illustrates a cross-sectional view of a guide arm of the adjustable surgical guide of FIG. 9 taken along line A-A, in accordance with some embodiments.

FIG. 12 illustrates an adjustable surgical guide including multiple position and angle adjustments, in accordance with some embodiments.

FIG. 13 illustrates a top view of the adjustable surgical guide of FIG. 12, in accordance with some embodiments.

FIG. 14 illustrates a side view of the adjustable surgical guide of FIG. 12, in accordance with some embodiments.

FIG. 15 illustrates a distal view of the adjustable surgical guide of FIG. 12, in accordance with some embodiments.

FIG. 16 illustrates a cross-sectional view of the adjustable surgical guide of FIG. 12 taken along line A-A, in accordance with some embodiments.

FIG. 17 is a flowchart illustrating a method of forming a cut in a bone using an adjustable surgical guide, in accordance with some embodiments.

FIG. 18 is a flowchart illustrating a method of positioning an adjustable surgical guide, in accordance with some embodiments.

DETAILED DESCRIPTION

This description of the exemplary embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description. In the description, relative terms such as “lower,” “upper,” “horizontal,” “vertical,”, “above,” “below,” “up,” “down,” “top,” “bottom,” “proximal,” “distal,” “superior,” “inferior,” “medial,” and “lateral” as well as derivative thereof (e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should be construed to refer to the orientation as then described or as shown in the drawing under discussion. These relative terms are for convenience of description and do not require that the apparatus be constructed or operated in a particular orientation. Terms concerning attachments, coupling and the like, such as “connected,” refer to a relationship wherein structures are secured or attached to one another either directly or indirectly through intervening structures, as well as both movable or rigid attachments or relationships, unless expressly described otherwise. Like elements have been given like numerical designations to facilitate an understanding of the present subject matter.

As used herein, the term “substantially” denotes elements having a recited relationship (e.g., parallel, perpendicular, aligned, etc.) within acceptable manufacturing tolerances. For example, as used herein, the term “substantially parallel” is used to denote elements that are parallel or that vary from a parallel arrangement within an acceptable margin of error, such as +/−5°, although it will be recognized that greater and/or lesser deviations can exist based on manufacturing processes and/or other manufacturing requirements.

In various embodiments, a surgical guide is disclosed. The surgical guide includes a first guide arm extending from a first end to a second end along a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end along a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A pivot element couples the first end of the first guide arm to the first end of the second guide arm such that an angle between the first guide arm and the second guide arm can be adjusted in a first plane.

FIGS. 1-4 illustrate an adjustable surgical guide 100 a, in accordance with some embodiments. The surgical guide 100 a includes a first guide arm 102 a and a second guide arm 102 b. Each of the guide arms 102 a, 102 b includes a body 104 extending between a proximal end 106 a and a distal end 106 b substantially along a longitudinal axis 150 a, 150 b. The body 104 of each guide arm 102 a, 102 b further extends between an upper surface 108 a and a lower surface 108 b and is defined by a perimeter wall 110. The perimeter wall 110 can define any suitably shape, such as, for example, a rectangular perimeter, an oval perimeter, etc. In some embodiments, a guide block 124 is coupled to an outer perimeter wall 112 b of the body 104 of each of the guide arms 102 a, 102 b.

In some embodiments, each of the guide arms 102 a, 102 b defines a plurality of guide holes 114 a, 114 b extending from the upper surface 108 a to the lower surface 108 b. For example, in the illustrated embodiment, the first guide arm 102 a defines a first plurality of guide holes 114 a arranged parallel to the first longitudinal axis 150 a and the second guide arm 102 b defines a second plurality of guide holes 114 b arranged parallel to the second longitudinal axis 150 b. Although specific embodiments are illustrated, it will be appreciated that the first and second plurality of guide holes 114 a, 114 b can extend through any suitable portion of respective first and second guide arms 102 a, 102 b. The guide holes 114 a, 114 b are each sized and configured to receive a guide element, such as a k-wire, a screw, etc., therethrough. The guide element provides a reference point for one or more additional guides, such as a cutting guide, couple to the guide element for subsequent surgical procedures.

In some embodiments, each of the guide holes 114 a, 114 b are defined by a guide extension 116 a, 116 b extending from an inner surface 112 a of the body 104. The guide extensions 116 a, 116 b define bumps (or peaks) extending from the body 104. In some embodiments, each of the guide extensions 116 a, 116 b defines a sloped guide surface 120 surrounding the guide hole 114 a, 114 b to guide a cutting element, such as a k-wire or burr, into the guide hole 114 a, 114 b. In some embodiments, the guide extensions 116 a, 116 b are alternated with cutouts 118 a, 118 b (or valleys). The guide extensions 116 a of the first guide arm 102 a are sized and positioned to fit within the cutouts 118 b of the second guide arm 102 b. Similarly, the guide extensions 116 b of the second guide arm 102 b are sized and positioned to fit within the cutouts 118 a of the first guide arm 102 b. The guide extensions 116 a, 116 b and the cutouts 118 a, 118 b allow the guide arms 102 a, 102 b to be interlocked in a flush arrangement.

In some embodiments, the first guide arm 102 a includes a third plurality of guide holes 122 a and/or the second guide arm 102 b includes a fourth plurality of guide holes 122 b. The guide holes 122 a, 122 b extend from the first surface 108 a to the second surface 108 b through a guide block 124 extending from an outer perimeter surface 112 b of the body 104. Each of the guide holes 122 a, 122 b is sized and configured to receive a fixation element, such as a k-wire, therethrough. The guide holes 122 a, 122 b are configured to guide the fixation element to a predetermined position on the bone. In some embodiments, the guide holes 122 a, 122 b are positioned on an axis substantially parallel to and offset from the longitudinal axis 150 a, 150 b and/or the first/second plurality of holes 114 a, 114 b of the respective guide arm 102 a, 102 b, although it will be appreciated that the guide holes 122 a, 122 b may be arranged in any pattern and extend through any portion of the guide body 104 and/or the guide block 124.

In some embodiments, the first guide arm 102 a is coupled to the second guide arm 102 b by a pivot element 130. The pivot element 130 is configured to limit respective movement of the first guide arm 102 a and the second guide arm 102 b to a single plane, such as, for example, a first plane intersecting (e.g., defined by) each of the longitudinal axes 150 a, 150 b. In some embodiments, the pivot element 130 is configured to allow movement of the first guide arm 102 a with respect to the second guide arm 102 b to adjust an angle Θ₁ defined in the first plane between the first guide arm 102 a and the second guide arm 102 b. The angle Θ₁ may be adjusted from a minimum angle to a maximum angle. For example, in some embodiments, the first guide arm 102 a and the second guide arm 102 b may be adjusted from a minimum angle of 0° (i.e., the first guide arm 102 a aligned in the same direction as the second guide arm 102 b) to a maximum angle of 180° (i.e., the first guide arm 102 a aligned in an opposite direction as the second guide arm 102 b). Although specific embodiments are discussed herein, it will be appreciated that the pivot element 130 can be configured to continuously and/or discretely adjust the angle Θ₁ within any predetermined range, such as, for example, 0-90°, 0-180°, 0-270°, 0-360°, and/or any other suitable range of angles.

In some embodiments, the pivot element 130 includes a first pivot arm 132 a and a second pivot arm 132 b coupled by a pin 134. The first pivot arm 132 a and the second pivot arm 132 b are pivotally coupled such that an angle (e.g., Θ₁) between the first pivot arm 132 a and the second pivot arm 132 b can be adjusted. For example, in the illustrated embodiment, the first pivot arm 132 a includes a first coupling portion 136 a sized and configured to fit within a second coupling portion 136 b of the second pivot arm 132 b. The second coupling portion 136 b defines a first arm 152 a spaced apart from a second arm 152 b to define a coupling channel 142 therebetween. The coupling channel 142 is sized and configured to receive the first coupling portion 136 a therein. When the first coupling portion 136 a is positioned between the first and second arms 152 a, 152 b of the second coupling portion 136 b, pin holes 151 defined in each of the first and second coupling portions 136 a, 136 b are aligned. The pin holes 151 are sized and configured to receive a pin 134 therein. The pin 134 couples the first coupling portion 136 a to the second coupling portion 136 b in a pivoting (or hinged) engagement. Although specific embodiments are discussed herein, it will be appreciated that any suitable coupling mechanism that provides pivoting movement of the first pivot arm 132 a with respect to the second pivot arm 132 b may be used, and is within the scope of this disclosure. In some embodiments, the pivot element 130 defines at least one hole (not shown) extending therethrough sized and configured to receive a k-wire, burr, or other element therethrough.

Each of the pivot arms 132 a, 132 b define a guide connection portion 138 a, 138 b coupled to and/or formed integrally with the respective first and second coupling elements 136 a, 136 b. The guide connection portions 138 a, 138 b each define a channel or opening 140 extending from a first surface 139 into the guide connection portion 138 a, 138 b. The channel 140 is sized and configured to receive a portion of a respective guide arm 102 a, 102 b therein. In some embodiments, the guide arm 102 a, 102 b is coupled to the guide connection portion 138 a, 138 b by a releasable locking mechanism 143. For example, in the illustrated embodiment, the releasable locking mechanism 143 includes an extension 144 extending from the guide connection portion 138 a, 138 b and defining a channel 153 therethrough. The channel 153 extends into and intersects the channel 140 extending into the guide connection portion 138 a, 138 b. The interior surface of the channel 153 is threaded. A locking element 144 is positioned at least partially within the channel 153.

As shown in FIG. 4, in some embodiments, the locking element 144 includes a threaded shaft 154 extending from an unthreaded head 156. The locking element 144 can be tightened and/or locked against the surface of the guide arm 102 a, 102 b to maintain the guide arm 102 a, 102 b in a fixed position with respect to the guide connection portion 138 a, 138 b. For example, in the illustrated embodiment, the threaded shaft 154 is rotatably interfaced with the internal threads of the channel 153 to tighten the locking element 144 against a respective guide arm 102 a, 102 b, although it will be appreciated that any suitable locking mechanism 143, such as a permanent and/or fixed locking mechanism, can be used to couple the guide arms 102 a, 102 b to respective guide connection portions 138 a, 138 b. In other embodiments, the pivot arms 132 a, 132 b are formed integrally with the guide arms 102 a, 102 b.

In use, and as described in greater detail below, the adjustable surgical guide 100 a is configured to guide insertion of a one or more guide elements, such as a k-wire, into the least one bone. A cut can be formed in a bone using one or more guide holes 114 a, 114 b and/or additional cutting guides coupled to one or more guide elements. For example, in some embodiments, a first guide arm 102 a of the adjustable surgical guide 100 a is positioned adjacent to a bone to position a first guide element in the bone. The guide element can include any suitable guide element, such as, for example, a k-wire. The guide element can be positioned based on pre-operative imaging, simultaneous imaging, and/or using any other method.

After coupling the first guide arm 102 a to the bone, an angle Θ₁ between the first guide arm 102 a and the second guide arm 102 b can be adjusted to position the second guide arm 102 b at predetermined position on the bone. For example, in some embodiments, the angle Θ₁ between the first guide arm 102 a and the second guide arm 102 b can be adjusted to any suitable angle within a predetermined range of angles, such as, for example, between 0-90°, 0-180°, 0-270°, 0-360°, and/or any other suitable range of angles. A second guide element is inserted through at least one hole 122 b extending through the second guide arm 102 b.

After coupling the guide elements to the bone, and as described in greater detail below, the adjustable surgical guide 100 a is removed from the surgical site and at least one cutting guide is coupled to one or more of the first guide element and the second guide element. A cutting instrument, such as a burr, saw, etc., may be positioned through the cutting guide and one or more cuts formed in the bone. In some embodiments, the adjustable surgical guide includes one or more openings sized and configured to guide the cutting instrument to a predetermined position and/or within a predetermined area of the bone. The cutting instrument forms a cut in the bone, for example, to form a wedge cut, osteotomy, and/or other cut in the bone. In some embodiments, the one or more openings include a slot sized and configured to position a blade or other cutting instrument along a predetermined axis to form a resection cut in the bone.

FIGS. 5-8 illustrates an embodiment of an adjustable surgical guide 100 b including guide arms 202 a, 202 b defining a plurality of scallop guides 216, in accordance with some embodiments. The adjustable surgical guide 100 b is similar to the adjustable surgical guide 100 a discussed in conjunction with FIGS. 1-4, and similar description is not repeated herein. Each of the guide arms 202 a, 202 b of the adjustable surgical guide 100 b includes a plurality of scallop guides 216 sized and configured to position a guide element within a hole 114 a, 114 b defined in the center of each of the scallop guides 216.

In some embodiments, each of the scallop guides 216 includes an inner surface 220 defining a sloped, or scalloped, funnel. A guide hole 114 a, 114 b is positioned at the apex (or lowest point) of the sloped inner surface 220. In some embodiments, the inner surface 220 is configured to control motion of a surgical instrument, such as, for example, a burr inserted through a guide hole 114 a, 114 b. In the illustrated embodiment, the scallop guides 216 formed in the first guide arm 202 a are aligned with the scallop guides 216 formed in the second guide arm 202 b. It will be appreciated that each of the guide arms 202 a, 202 b can include a greater or lesser number of scallop guides 216 aligned with and/or offset from scallop guides 216 in the other of the guide arms 202 a, 202 b.

FIGS. 9-11 illustrate an embodiment of an adjustable surgical guide 100 c including first and second guide arms 302 a, 302 b each defining slots 310 a, 310 b sized and configured to receive one or more sliding guide elements 312 a-312 d therein, in accordance with some embodiments. The adjustable surgical guide 100 c is similar to the adjustable surgical guide 100 a discussed in conjunction with FIGS. 1-4, and similar description is not repeated herein. In some embodiments, each of the guide arms 302 a, 302 b defines a slot 310 a, 310 b extending substantially along the longitudinal axis 150 a, 150 b of the respective guide arm 302 a, 302 b. In the illustrated embodiment, the slot 310 a, 310 b extends substantially from a proximal end 106 a of each guide arm 302 a, 302 b to a distal end 106 b of each guide arm 302 a, 302 b, although it will be appreciated that the slots 310 a, 310 b can extend over any portion of the respective guide arm 302 a, 302 b and is within the scope of this disclosure.

In some embodiments, each slot 310 a, 310 b is sized and configured to receive one or more sliding guide elements 312 a-312 d therein. Each of the sliding guide elements 312 a-312 d include a guide portion 316 coupled to a locking portion 320. The guide portion 316 includes an extension 322 (see FIG. 11) sized and configured to extend through a slot 310 a, 310 b of the respective guide arm 302 a, 302 b. The locking portion 320 is coupled to the extension 322. In some embodiments, the locking portion 320 is configured to maintain the sliding guide element 312 a-312 d in a fixed position within the slot 310 a, 310 b. For example, in some embodiments, the guide portion 316 of each of the sliding guide elements 312 a 0-312 d includes a first surface configured to abut the respective guide arm 302 a, 302 b on a first side. The locking portion 320 includes a second surface configured to abut the respective guide arm 302 a, 302 b on a second side. When the locking portion 320 is tightened to the guide portion 316 (for example, by rotating the locking portion 320 to engage threads formed on the extension 322), the first and second surfaces form a friction lock that prevents movement of the slideable guide element 312 a-312 d within the slot 310 a, 310 b.

In some embodiments, the guide portion 316 defines a guide hole 314 extending therethrough. The guide hole 314 is sized and configured to receive a guide element, a cutting element, and/or any other suitable element therethrough. For example, in some embodiments, at least one guide hole 314 is sized and configured to receive a guide element such that the guide element is coupled to a bone at a predetermined location. In some embodiments, a guide element and/or a cutting element may be inserted through a guide hole and the sliding guide element 312 a-312 d may be subsequently traversed through the slot 310 a, 310 b to select a position for insertion with respect to the bone along an axis parallel to the axis of the guide arm 302 a, 302 b and/or the slot 310 a, 310 b.

In some embodiments, one or more of the guide arms 302 a, 302 b includes a second guide portion 330 a, 330 b extending along a longitudinal axis 350 a, 350 b disposed at a predetermined angle α, β with respect to the longitudinal axis 150 a, 150 b of the respective guide arm 302 a, 302 b. For example, in the illustrated embodiment, each of the guide arms 302 a, 302 b includes a second guide portion 330 a, 330 b extending along a third longitudinal axis 350 a and a fourth longitudinal axis 350 b, respectively, each positioned at an angle of about 90° with respect to the respective first or second longitudinal axis 150 a, 150 b. The second guide portion 330 defines a second slot 332 a, 332 b sized and configured to receive a sliding guide element 312 a-312 d therein. The second slot 332 a, 332 b is configured to guide the sliding guide element 312 a-312 d along the third or fourth longitudinal axis 350 a, 350 b. For example, in some embodiments, the second slot 332 a, 332 b positions a sliding guide element 312 a-312 d such that a guide element can be located within the bone at an angle α, β with respect to a guide element positioned within the bone by a sliding guide element 312 a-312 d positioned within the first slot 310 a, 310 b.

In some embodiments, the first slot 310 a, 310 b and the second slot 332 a, 332 b are coupled to form a continuous adjustment slot 334 a, 33 b configured to allow continuous movement of a slideable guide element 312 a-312 b along a first axis 150 a, 150 b and/or a second axis 350 a, 350 b depending on the position of the slideable guide element 312 a-312 d within the continuous adjustment slot 334. Although embodiments are illustrated with a single continuous adjustment slot 334 a, 334 b including a first slot 310 a, 310 b and a second slot 332 a, 332 b, it will be appreciated that the guide arms 302 a, 302 b can define any number of continuous and/or discrete slots.

FIGS. 12-16 illustrate an adjustable surgical guide 100 d including multiple position and angle adjustments, in accordance with some embodiments. The surgical guide 100 d is similar to the surgical guides 100 a, 100 b, 100 c discussed in conjunction with FIGS. 1-11, and similar description is not repeated herein. The surgical guide 100 d includes a first extension arm 402 a having a first guide arm 426 a extending therefrom and a second extension arm 402 b having a second guide arm 426 b extending therefrom. The first extension arm 402 a and the second extension arm 402 b are coupled by a pivot element 430. As discussed above with respect to the surgical guide 100 a, the pivot element 430 is configured to adjust a first angle Θ₁ in a first plane between the first extension arm 402 a (or the first guide arm 426 a) and the second extension arm (or the second guide arm 426 b). As discussed in greater detail below, in some embodiments, the pivot element 430 is configured to adjust a second angle Θ₂ between the first extension arm 402 a and a lateral adjustment arm 460 and a third angle Θ₃ between the second extension arm 402 b and the lateral adjustment arm 460 in the first plane.

Each of the extension arms 402 a, 402 b includes a body 422 extending substantially along a first longitudinal axis 450 a or a second longitudinal axis 450 b, respectively. The body 422 extends between an upper surface 422 a and a lower surface 422 b and is defined by a side wall 424. Each extension arm 402 a, 402 b defines a slot 416 a, 416 b extending from the upper surface 422 a through the body 422 to the lower surface 422 b. Each slot 416 a, 416 b is sized and configured to receive a threaded connector 440 of a respective guide arm 426 a, 426 b, therethrough. Each of the extension arms 402 a, 402 b include a proximal portion sized and configured to couple to a respective guide connection portion 438 a, 438 b of the pivot element 430. The extension arms 402 a, 402 b can be retained within the guide connection portion 438 a, 438 b using any suitable retention mechanism, such as a friction retention, a threaded retention, the use of tightening element, and/or any other suitable retention mechanism.

In some embodiments, a guide arm 426 a, 426 b is slideably coupled to a respective one of the extension arms 402 a, 402 b. Each of the guide arms 426 a, 426 b extend from a proximal end 428 a to a distal end 428 b. The first guide arm 426 a extends substantially along a third longitudinal axis and the second guide arm 426 b extends substantially along a fourth longitudinal axis 450 d. The guide arms 426 a, 426 b each include a body 425 extending between a first surface 429 a and a second surface 429 b and defined by a sidewall 427. A plurality of guide holes 454 extend from the first surface 429 a to the second surface 429. In the illustrated embodiments, each of the guide holes 454 extends along an axis that is perpendicular to the longitudinal axis 450 c, 450 d of the respective guide arm 426 a, 426 b, although it will be appreciated that the guide holes 454 can extend through the guide arms 426 a, 426 b at any suitable angle and are within the scope of this disclosure. Although the guide holes 454 are illustrated extending from a first surface 429 a to a second surface 429 b, it will be appreciated that the guide holes 454 can also extend from a third surface 429 c to a fourth surface 429 b.

In some embodiments, each guide arm 426 a, 426 b is coupled to a respective extension arm 402 a, 402 b by a pivoting slide element 445. The pivoting slide element 445 includes a pivot element 445 comprising a first pivot connector 448 formed integrally with a proximal end 446 of the guide arms 426 a, 426 b and a second pivot connector 444 comprising a connection extension 440 sized and configured to extend through the slot 416 a, 416 b. The first pivot connector 448 is coupled to the second pivot connector 444 by a pivot pin 452 extending through holes formed in each of the pivot connectors 444, 448. In some embodiments, the pivot element 445 allows adjustment of an angle Θ₄, Θ₅ between a guide arm 426 a, 426 b and a respective one of the extension arms 402 a, 402 b in a plane defined by the longitudinal axis 450 a, 450 b of the respective extension arm 402 a, 402 b and the longitudinal axis 450 c, 450 d of the respective guide arm 426 a, 426 b. In various embodiments, the angles Θ₄, Θ₅ can be any angle within a predetermined range of angles, such as, for example, any angle within a range of 0°-90°, 0°-180°, 45°-90°, and/or any other suitable range of angles.

In some embodiments, each of the pivot elements 445 includes a connection extension 440 extending through the slot 416 a, 416 b. The connection extension 440 is configured to slideably couple the guide arm 426 a, 426 b to the respective extension arm 402 a, 402 b. For example, in the illustrated embodiment, the connection extension 440 includes a threaded shaft extending from the second pivot connector 444. The threaded shaft is configured to threadably couple to internal threads of a locking element 442. The locking element 442 is threaded onto the threaded shaft and maintains the connection extension 440 within the slot 416 a, 416 b. The position of the guide arm 426 a, 426 b along a longitudinal axis 450 a, 450 b defined by the respective extension arm 402 a, 402 b can be adjusted by sliding the connection extension 440 within the slot 416 a, 416 b. In some embodiments, the locking element 442 can be tightened to lock the position of the targeting arm 426 a, 426 b within the slot 416.

In some embodiments, each guide arm 426 a, 426 b is configured to rotate about the respective longitudinal axis 450 c, 450 d of the guide arm 426 a, 426 b. For example, in the illustrated embodiment, the second pivot connector 444 includes a threaded connection extension 440 extending through the slot 416. The locking element 442 can be loosened to allow rotation of the guide arm 426 a, 426 b about the respective longitudinal axis 450 c, 450 d. After setting an angle of rotation of the guide arm 426 a, 426 b, the locking element 442 is tightened to fix the rotational position of the guide arm 426 a, 426 b at the selected angle of rotation γ₁, γ₂. The angle of rotation γ₁, γ₂ can include any suitable angle of rotation, such as, for example, any angle between 0°-360°. In some embodiments, the selected angle of rotation γ₁, γ₂ can be adjusted by rotating each of the guide arms 426 a, 426 b with respect to the pivot element 445 such that the selected angle of rotation γ₁, γ₂ of the guide arms 426 a, 426 b can be adjusted to position the guide arms 426 a, 426 b at any angular position with respect to the pivot element 445. Although embodiments are discussed herein including rotatable guide arms 426 a, 426 b, it will be appreciated that the guide arms 426 a, 426 b can have a fixed rotational orientation with respect to the extension arms 402 a, 402 b, in some embodiments.

In some embodiments, the adjustable surgical guide 100 d includes a lateral adjustment arm 460 including a body 461 extending substantially along a fifth longitudinal axis 450 e from a first end 466 a to a second end 466 b. The body 461 extends between a first surface 464 a and a second surface 464 b and is defined by a perimeter wall 468. In some embodiments, one or more guide holes 470 extend through the body 461 from the first surface 464 a to the second surface 464 b. The guide holes 470 are sized and configured to receive a guide element and/or any other suitable element therethrough. The lateral adjustment arm 460 is configured to provide lateral movement of the pivot element 430 and the extension arms 402 a, 402 b parallel to the fifth axis 450 e.

For example, in some embodiments, the pivot element 430 is coupled to the lateral adjustment arm 460 by a lateral adjustment component 476. The lateral adjustment component 476 includes a body 477 configured to slideably contact the first surface 464 a of the longitudinal adjustment arm 460. A slide element 478 is coupled to the body 477 and is configured to maintain the body 477 in contact with the first surface 464 a. The slide element 478 can be positioned within a slot 462 defined in the lateral adjustment arm 460 and/or in contact with the second surface 464 b of the lateral adjustment arm 460.

In some embodiments, a pivot connector 480 extends from the body 477. The pivot connector 480 defines a pivot pin hole 481 sized and configured to receive the pivot pin 434 therethrough. The pivot pin 434 couples the pivot element 430 to the lateral adjustment component 476. For example, in the illustrated embodiment, the pivot pin 434 extend through the pivot pin hole 481 and is coupled to the locking element 435.

In some embodiments, the slide element 478 can be moved laterally within the slot 462 to move the pivot element 430 and, by extension, the extension arms 402 a, 402 b. In some embodiments, the slide element 478 is coupled to the body 477 by a locking pin 472 having a head 457 in contact with the slide element 478 and a shaft 479 extending through the body 477 of the lateral adjustment component 476. A locking element 474 defines an internal channel 481 having internal threads configured to engage the threads of the locking pin 472 to fix the position of the slide element 478 within the slot 462.

In some embodiments, the pivot pin 434 is configured to allow rotation of the pivot element 430 to adjust a second angle Θ₂ between the first extension arm 402 a (or first guide arm 426 a) and the horizontal adjustment arm 460 and a third angle Θ₃ between the second extension arm 402 b (or second guide arm 426 b) and the horizontal adjustment arm 460. For example, in some embodiments, the locking element 435 can be loosened with respect to the pivot pin 434 such that the pivot element 430 is able to rotate about the pivot pin 434 with respect to the pivot connector 480. Rotational movement of the pivot element 430 adjusts the second angle Θ₂ between the first extension arm 402 a and the lateral adjustment arm 460 and the third angle Θ₃ between the second extension arm 402 b and the lateral adjustment arm 460 while maintaining the first angle Θ₁ between the first and second extension arms 402 a, 402 b. Although embodiments are illustrated with a rotatable pivot element 430, it will be appreciated that the rotational angle of the pivot element 430 may be fixed with respect to the pivot connector 480 and adjustments of the angles Θ₁, Θ₂, and Θ₃ may be accomplished solely by movement of the extension arms 402 a, 402 b with respect to each other.

FIG. 17 illustrates a method 500 of forming a cut in a bone, in accordance with some embodiments. At step 502, an adjustable surgical guide 100 d is positioned adjacent to a bone. Although embodiments are discussed herein with respect to the adjustable surgical guide 100 a-100 d, it will be appreciated that any of the surgical guides 100 a-100 d discussed above can be used in conjunction with the method 500 and such use is within the scope of this disclosure. In some embodiments, an adjustable surgical guide 100 a includes a first guide arm 102 a extending substantially on a first longitudinal axis 150 a and defining a first plurality of openings 114 a, a second guide arm 102 b extending substantially on a second longitudinal axis 150 b and defining a second plurality of openings 114 b, and a pivot element 130 coupling the first guide arm 102 a to the second guide arm 102 b. In some embodiments, a temporary fixation element, such as a k-wire, may be inserted through a hole defined through the pivot element 130, such as a hole extending through a pivot pin 134, to maintain the adjustable surgical guide 100 a at a predetermined position with respect to the bone.

At optional step 504, a first guide element is inserted through a selected one of the first plurality of openings 122 a defined by the first guide arm 102 a. For example, in some embodiments, a first guide element, such as a k-wire, is inserted through a selected one of the holes 122 a defined in the first guide arm 102 a. The first guide element can be coupled to a bone, for example, prior to and/or after insertion of the first guide element through the selected one of the plurality of holes 122 a to define a first reference point for a wedge osteotomy to be formed in the bone.

At optional step 506, the first guide arm 102 a and the second guide arm 102 b are pivoted about the pivot element 130 to adjust the angle Θ₁ between the first guide arm 102 a and the second guide arm 102 b within the first plane. In some embodiments, pivoting the first guide arm 102 a and the second guide arm 102 b includes increasing and/or decreasing the first angle Θ₁ between the first guide arm 102 a and the second guide arm 102 b to define the width of a wedge osteotomy to be formed in a bone.

At optional step 508, a longitudinal position of a first guide arm 426 a, a second guide arm 426 b, and a pivot element 430 is adjusted along a third longitudinal axis 450 e. For example, in some embodiments, the adjustable surgical guide 100 d includes a lateral adjustment arm 460 defining a slot 462. The slot is configured to receive a slide element 478 therein. The slide element 478 is coupled to the pivot element 430 and is configured to move the pivot element 430 laterally along the third longitudinal axis 450 e. In some embodiments, the lateral adjustment arm 460 is coupled to the bone by a third guide element prior to and/or subsequent to adjusting the lateral position of the pivot element 430.

At optional step 510, a longitudinal position of the first guide arm 426 a and/or the second guide arm 426 b is adjusted with respect to the pivot element 430. For example, in some embodiments, each of the first guide arm 426 a and the second guide arm 426 b include a slide element 440 disposed through a slot 416 defined by a respective extension arm 402 a, 402 b coupled to the pivot element 430. Each of the extension arms 402 a, 402 b and the corresponding slot 416 extend substantially along a longitudinal axis 450 a, 450 b. In some embodiments, a locking element 442 is coupled to the slide element 440 and can be tightened to fix the position of the guide arm 426 a, 426 b within the slot 416 and/or can be loosened to allow adjustment of the guide arm 426 a, 426 b within the slot 416.

At optional step 512, an angle of the first guide arm 426 a and/or the second guide arm 426 b is adjusted with respect to a pivot plane defined by the pivot element 430. For example, in some embodiments, the first guide arm 426 a comprises an angular pivot element 444 configured to selectively adjust the angle between the longitudinal axis 450 c of the first guide arm 426 a or the longitudinal axis 450 d of the second guide arm 426 b and the pivot plane. In some embodiments, the pivot plane includes a plane defined by the longitudinal axes 450 a, 450 b of the guide arm connectors 432 a, 432 b of the pivot element 430.

At optional step 514, a second guide element is inserted through a selected one of the second plurality of openings 122 b defined by the second guide arm 102 b. For example, in some embodiments, a second guide element, such as a k-wire, is inserted through the selected one of the holes 122 b defined in the second guide arm 102 b. The second guide element is coupled to a bone to define a second point of reference for a wedge osteotomy to be formed in the bone.

At step 516, a cutting guide is inserted through one or more of the guide holes 114 a, 114 b, 214, 454, extending through a portion of the adjustable surgical guide. The cutting instrument, such as a burr, is sequentially inserted into the one or more guide holes 114 a, 114 b, 214, 454 to form a wedge osteotomy in the bone. In some embodiments, a cut may be formed in the bone by pivoting and/or rotating the cutting instrument within a guide hole 114 a, 114 b, such as, for example. within a range of motion defined by a scallop guide 216.

FIG. 18 illustrates a method 500 a of forming a cut in a bone using an adjustable surgical guide having at least one slideable guide element, in accordance with some embodiments. Steps 502-506 of the method 500 a are similar to steps 502-206 of the method 500 discussed above in conjunction with FIG. 17, and similar description is not repeated herein. At step 530, the position of at least one slideable guide element 312 within a slot 310 defined by one of a first guide arm 302 a or a second guide arm 302 b is adjusted. The slideable guide element 312 can include a locking element 320 that is loosened to allow movement of the slideable guide element 312 within the slot 310. After repositioning the slideable guide element 312, the locking portion 320 can be retightened to fix the position of the slideable guide element 312 within the slot 310. For example, in some embodiments, the guide portion 316 of each of the sliding guide elements 312 a first surface configured to abut the guide arm 302 a, 302 b on a first side. The locking portion 320 includes a second surface configured to abut the guide arm 302 a, 302 b on a second side. When the locking portion 320 is tightened to the guide portion 316 (for example, by rotating the locking portion 320 to engage threads formed on the extension 322), the first and second surfaces form a friction lock that prevents movement of the slideable guide element 312 within the slot 310. The method 500 a proceeds to step 516 and continues through the method steps discussed above with respect to method 500.

Although the invention has been described in terms of exemplary embodiments, it is not limited thereto. Rather, the appended claims should be construed broadly, to include other variants and embodiments of the invention, which may be made by those skilled in the art without departing from the scope and range of equivalents of the invention. 

What is claimed is:
 1. A surgical guide, comprising: a first guide arm extending from a first end to a second end on a first longitudinal axis, the first guide arm defining a first plurality of openings sized and configured to receive a first guide element therethrough; a second guide arm extending from a first end to a second end on a second longitudinal axis, the second guide arm defining a second plurality of openings sized and configured to receive a second guide element therethrough; and a pivot element coupling the first end of the first guide arm to the first end of the second guide arm such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.
 2. The surgical guide of claim 1, comprising: a lateral adjustment arm extending from a first end to a second end on a third longitudinal axis, the lateral adjustment arm defining a slot extending substantially along the third longitudinal axis; and a slide element coupled to the pivot element and sized and configured to be received within the slot, wherein the slide element is configured to provide movement of the pivot element on the third longitudinal axis and within the first plane; and a locking element coupled to the slide element, wherein the locking element is configured to selectively fix a position of the slide element within the slot.
 3. The surgical guide of claim 2, wherein the guide element defines a plurality of openings sized and configured to receive a third guide element therethrough.
 4. The surgical guide of claim 1, comprising a first extension arm extending on a third longitudinal axis and defining an adjustment slot extending substantially along the third longitudinal axis.
 5. The surgical guide of claim 4, wherein the first guide arm comprises a first slide element sized and configured to be received within the adjustment slot defined by the first extension element, wherein the first slide element is configured to provide longitudinal movement of the first guide arm on the third longitudinal axis.
 6. The surgical guide of claim 4, wherein the first guide arm extends from the first slide element and out of the first plane.
 7. The surgical guide of claim 6, wherein the first guide arm comprises an angular pivot element configured to selectively adjust an angle between first longitudinal axis of the first guide arm and the first plane.
 8. The surgical guide of claim 1, comprising a first guide block coupled to the first guide arm, the first guide block extending substantially along a third longitudinal axis that is parallel to the first longitudinal axis, wherein the first guide block defines a first subset of the first plurality of openings.
 9. The surgical guide of claim 1, wherein the first guide arm defines a plurality of scallop guides sized and configured to guide the first guide element into a respective one of the plurality of openings.
 10. The surgical guide of claim 1, comprising a first locking element configured to releasably couple the first guide arm to the pivot element.
 11. The surgical guide of claim 1, wherein the first guide arm defines a slot having a first portion extending substantially along the first longitudinal axis, the first guide arm comprising a plurality of slideable guide elements disposed within the slot, wherein the slideable guide elements each define at least one of the first plurality of openings.
 12. The surgical guide of claim 11, wherein the first guide arm defines an offset portion extending on a third longitudinal axis having a predetermined non-zero angle with respect to the first longitudinal axis, and wherein the offset portion defines a second portion of the slot.
 13. A surgical method, comprising: positioning a surgical guide adjacent to a bone, the surgical guide comprising a first guide arm extending substantially on a first longitudinal axis and defining a first plurality of openings, a second guide arm extending substantially on a second longitudinal axis and defining a second plurality of openings, and a pivot element coupling the first guide arm to the second guide arm; inserting a first guide element through a selected one of the first plurality of openings defined by the first guide arm; pivoting the first guide arm and the second guide arm about the pivot element to adjust an angular distance between the first guide arm and the second guide arm; inserting a second guide element through a selected one of the second plurality of openings defined by the second guide arm; and forming at least one cut in the bone, wherein the first guide element and the second guide element are configured to position a cutting guide for forming the wedge osteotomy.
 14. The surgical method of claim 13, comprising adjusting a longitudinal position of the first guide arm, the second guide arm, and the pivot element on a third longitudinal axis, wherein the pivot element comprises a slide element disposed within a slot defined by a lateral adjustment arm and extending substantially along the third longitudinal axis.
 15. The surgical method of claim 13, comprising adjusting a longitudinal position of the first guide arm with respect to the pivot element, wherein the first guide arm comprises a slide element disposed within a slot defined by an extension element coupled to the pivot element, and wherein the extension element and the slot extend substantially along the third longitudinal axis.
 16. The surgical method of claim 13, comprising adjusting an angle of the first guide arm with respect to a pivot plane defined by the pivot element, wherein the first guide arm comprises an angular pivot element configured to selectively adjust the angle between the first longitudinal axis of the first guide arm and the pivot plane.
 17. The surgical method of claim 13, comprising adjusting a position of at least one slideable guide element positioned within a slot defined by the first guide arm, the at least one slidable element defining at least one of the first plurality of openings.
 18. A surgical guide, comprising: a first guide arm extending from a first end to a second end on a first longitudinal axis, the first guide arm defining a first plurality of openings sized and configured to receive a first guide element therethrough; a second guide arm extending from a first end to a second end on a second longitudinal axis, the second guide arm defining a second plurality of openings sized and configured to receive a second guide element therethrough; a first slide element coupled to the first end of the first guide arm; a first extension element extending from a first end to a second end on a third longitudinal axis and defining a first adjustment slot extending substantially on the third longitudinal axis, wherein the first slide element is positioned at least partially within the first slot and is slideable on the third longitudinal axis; a second slide element coupled to the first end of the second guide arm; a second extension element extending from a first end to a second end on a fourth longitudinal axis and defining a second adjustment slot extending substantially on the fourth longitudinal axis, wherein the second slide element is positioned at least partially within the second slot and is slideable on the fourth longitudinal axis; and a pivot element coupling the first end of the first extension element to the first end of the second extension element such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.
 19. The surgical guide of claim 18, comprising: a first angular pivot element coupled between the first slide element and the first guide arm; and a second angular pivot element coupled between the second slide element and the second guide arm, wherein the first angular pivot element is configured to adjust an angle between the first longitudinal axis of the first guide arm and the third longitudinal axis of the first extension element, and wherein the second angular pivot element is configured to adjust an angle between the second longitudinal axis of the second guide arm and the fourth longitudinal axis of the second extension element.
 20. The surgical guide of claim 18, comprising: a lateral adjustment arm extending from a first end to a second end on a fifth longitudinal axis, the lateral adjustment arm defining a slot extending substantially along the fifth longitudinal axis; and a longitudinal slide element coupled to the pivot element and sized and configured to be received within the slot, wherein the longitudinal slide element is configured to provide movement of the pivot element on the fifth longitudinal axis and within the first plane. 